Understanding the Link Between PTSD and Addiction

May 3, 2019

Anyone who has spent more than five minutes in a recovery group is bound to have noticed that a lot of people struggling with addiction have experienced trauma. Whether that is childhood abuse, a devastating car accident, the sudden unexpected loss of a loved one, combat trauma, sexual assault, or something else, trauma and substance use are intimately connected. This is even more true for those who experience post-traumatic stress disorder (PTSD)

What Is PTSD?

PTSD is characterized by a cluster of difficult symptoms, including intrusive nightmares, obsessive thoughts or flashbacks about the traumatic event(s), social anxiety, avoidance of people or places that serve as reminders to the event, feeling on constant alert (hypervigilance), dissociation, social isolation, and suicidal ideation or other forms of severe depression. These are just a few examples of the many, complex symptoms that mark PTSD. PTSD is highly individual; it manifests differently in different people, which means that not everyone will have all of these symptoms, but in order to be diagnosed with the disorder, they will have some of them. Not everyone who experiences trauma will develop PTSD, however; those who end up with these persistent symptoms are also at a heightened risk for developing a substance use disorder.

Opioids and PTSD

While addiction in general is linked with PTSD, depressants like alcohol and heroin pose a special risk. This is because depressants help mitigate some of the symptoms of PTSD, like hyper-arousal, anxiety, and uncomfortable emotions. Interestingly, there may be a link between opioids and the suppression of severe traumatic reactions. For example, a unique, groundbreaking 2009 study of pediatric patients who had suffered severe burn wounds discovered that those patients who were administered higher doses of morphine during recovery were less likely to develop as many PTSD symptoms three to six months later. Likewise, buprenorphine, a partial opioid agonist used to treat opioid use disorder, has been linked with a decrease in PTSD symptoms in combat veterans who co-occurring PTSD, opioid addiction, and chronic pain.

Of course, prolonged use of opioids will lead to a physical dependency in virtually anyone. A dependency means that a person’s body has become so used to a drug that without it, the person will experience uncomfortable withdrawal symptoms like body aches, vomiting, restlessness, and sweating. Dependency is a common side-effect of many substance, not just opioids. Alcohol, benzodiazepines, and even some anti-depressants will also produce dependency in people who use them long-term. Dependency is not necessarily a reason not to prescribe a medication, but it is a factor for consideration when weighing the pros and cons. When it comes to opioids, there is such a strong link between trauma and the compulsive use that characterizes addiction, that this class of drugs is not a viable treatment for PTSD, even if it does legitimately help suppress some symptoms.

What Should You Do?

If you are a trauma survivor and you find yourself struggling with addiction to alcohol, opioids, or another substance, it is important to treat your symptoms holistically. Treatment professionals once believed that it was necessary to first treat the addiction before addressing the trauma, but many practitioners have moved away from that model in the past several years, instead recognizing that in order to quell chaotic drug use in trauma survivors, the trauma must be dealt with. This looks different for different people, but it could, for example, mean engaging in pharmacotherapy like methadone or buprenorphine while also going to weekly trauma counseling. Reach out to a mental health and addiction provider so that you can come up with a treatment plan tailored to your specific needs.

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